FORM 1023-EZ for PRAIRIE MOUNTAIN NUTRITION INC

Field Data
EIN 82-3401848
Case Number EO-2017320-000420
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PRAIRIE MOUNTAIN NUTRITION INC
Organization’s Mailing Address PO BOX 37
City COTTONWOOD
State ID
ZIP 83522
Accounting period End 6
Primary contact name BRANDY MCELROY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOYCE FORSMANN
PRESIDENT
502 POWERLINE RD
GRANGEVILLE ID 83530

Officer/Director/Trustee Two

CHRISTINE REMACLE
VICE PRESIDENT
242 ST MICHAELS RD
COTTONWOOD ID 83522

Officer/Director/Trustee Three

GABRIELLE REHDER
SECRETARY
1926A GRAVES CREEK RD
COTTONWOOD ID 83522

Officer/Director/Trustee Four

BRANDY MCELROY
TREASURER
114 DASENBROCK RD
COTTONWOOD ID 83522

Officer/Director/Trustee Five

MARY FUNKE
DIRECTOR
190 WINDY LOOP RD
COTTONWOOD ID 83522

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/2/2017
Organization Incorporation State ID
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K40 - Nutrition Programs
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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